|
HC STYLET STR 0.016 59CM
|
Facility
OP
|
$187.50
|
|
| Hospital Charge Code |
41607295
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.88 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$158.25
|
| Rate for Payer: Aetna Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$107.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.06
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Centivo All Commercial |
$95.62
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Humana Medicare |
$95.62
|
| Rate for Payer: Lucent All Commercial |
$95.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.12
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$159.38
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
| Rate for Payer: United Healthcare Medicare |
$61.88
|
|
|
HC STYLET STR .014 45CM SOFT
|
Facility
OP
|
$187.50
|
|
| Hospital Charge Code |
41607285
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.88 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$158.25
|
| Rate for Payer: Aetna Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$107.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.06
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Centivo All Commercial |
$95.62
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Humana Medicare |
$95.62
|
| Rate for Payer: Lucent All Commercial |
$95.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.12
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$159.38
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
| Rate for Payer: United Healthcare Medicare |
$61.88
|
|
|
HC STYLET STR .014 45CM SOFT
|
Facility
IP
|
$187.50
|
|
| Hospital Charge Code |
41607285
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.62 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
|
|
HC STYLET STR .014 52CM SOFT
|
Facility
OP
|
$187.50
|
|
| Hospital Charge Code |
41607292
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.88 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$158.25
|
| Rate for Payer: Aetna Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$107.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.06
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Centivo All Commercial |
$95.62
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Humana Medicare |
$95.62
|
| Rate for Payer: Lucent All Commercial |
$95.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.12
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$159.38
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
| Rate for Payer: United Healthcare Medicare |
$61.88
|
|
|
HC STYLET STR .014 52CM SOFT
|
Facility
IP
|
$187.50
|
|
| Hospital Charge Code |
41607292
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.62 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
|
|
HC STYLET STR .014 64CM
|
Facility
OP
|
$187.50
|
|
| Hospital Charge Code |
41607309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.88 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$158.25
|
| Rate for Payer: Aetna Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$107.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.06
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Centivo All Commercial |
$95.62
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Humana Medicare |
$95.62
|
| Rate for Payer: Lucent All Commercial |
$95.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.12
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$159.38
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
| Rate for Payer: United Healthcare Medicare |
$61.88
|
|
|
HC STYLET STR .014 64CM
|
Facility
IP
|
$187.50
|
|
| Hospital Charge Code |
41607309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.62 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
|
|
HC STYLET STR .014 70CM
|
Facility
OP
|
$187.50
|
|
| Hospital Charge Code |
41607307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.88 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$158.25
|
| Rate for Payer: Aetna Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$107.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.06
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Centivo All Commercial |
$95.62
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Humana Medicare |
$95.62
|
| Rate for Payer: Lucent All Commercial |
$95.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.12
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$159.38
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
| Rate for Payer: United Healthcare Medicare |
$61.88
|
|
|
HC STYLET STR .014 70CM
|
Facility
IP
|
$187.50
|
|
| Hospital Charge Code |
41607307
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.62 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
|
|
HC STYLET STR .016 45CM
|
Facility
IP
|
$187.50
|
|
| Hospital Charge Code |
41607287
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.62 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
|
|
HC STYLET STR .016 45CM
|
Facility
OP
|
$187.50
|
|
| Hospital Charge Code |
41607287
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.88 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$158.25
|
| Rate for Payer: Aetna Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$107.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.06
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Centivo All Commercial |
$95.62
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Humana Medicare |
$95.62
|
| Rate for Payer: Lucent All Commercial |
$95.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.12
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$159.38
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
| Rate for Payer: United Healthcare Medicare |
$61.88
|
|
|
HC STYLET STR .016 52CM
|
Facility
IP
|
$187.50
|
|
| Hospital Charge Code |
41607290
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.62 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
|
|
HC STYLET STR .016 52CM
|
Facility
OP
|
$187.50
|
|
| Hospital Charge Code |
41607290
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.88 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$158.25
|
| Rate for Payer: Aetna Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$107.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.06
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Centivo All Commercial |
$95.62
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Humana Medicare |
$95.62
|
| Rate for Payer: Lucent All Commercial |
$95.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.12
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$159.38
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
| Rate for Payer: United Healthcare Medicare |
$61.88
|
|
|
HC STYLET STR .016 64CM
|
Facility
OP
|
$187.50
|
|
| Hospital Charge Code |
41607308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.88 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$158.25
|
| Rate for Payer: Aetna Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$107.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.06
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Centivo All Commercial |
$95.62
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Humana Medicare |
$95.62
|
| Rate for Payer: Lucent All Commercial |
$95.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.12
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$159.38
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
| Rate for Payer: United Healthcare Medicare |
$61.88
|
|
|
HC STYLET STR .016 64CM
|
Facility
IP
|
$187.50
|
|
| Hospital Charge Code |
41607308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.62 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
|
|
HC STYLET STR .016 70CM
|
Facility
IP
|
$187.50
|
|
| Hospital Charge Code |
41607306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.62 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
|
|
HC STYLET STR .016 70CM
|
Facility
OP
|
$187.50
|
|
| Hospital Charge Code |
41607306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.88 |
| Max. Negotiated Rate |
$174.38 |
| Rate for Payer: Aetna Commercial |
$158.25
|
| Rate for Payer: Aetna Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$61.88
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$107.68
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$117.21
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$71.16
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$68.06
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Cash Price |
$116.25
|
| Rate for Payer: Centivo All Commercial |
$95.62
|
| Rate for Payer: Cigna All Commercial |
$161.81
|
| Rate for Payer: CORVEL All Commercial |
$174.38
|
| Rate for Payer: Coventry All Commercial |
$165.00
|
| Rate for Payer: Encore All Commercial |
$172.59
|
| Rate for Payer: Frontpath All Commercial |
$172.50
|
| Rate for Payer: Humana ChoiceCare |
$161.94
|
| Rate for Payer: Humana Medicare |
$95.62
|
| Rate for Payer: Lucent All Commercial |
$95.62
|
| Rate for Payer: Lutheran Preferred All Commercial |
$168.75
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$140.62
|
| Rate for Payer: PHP All Commercial |
$142.20
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$73.12
|
| Rate for Payer: Sagamore Health Network All Products |
$144.75
|
| Rate for Payer: Signature Care EPO |
$155.62
|
| Rate for Payer: Signature Care PPO |
$165.00
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$159.38
|
| Rate for Payer: United Healthcare Commercial |
$147.75
|
| Rate for Payer: United Healthcare Medicare |
$61.88
|
|
|
HC STYLETTE 12FR
|
Facility
OP
|
$10.79
|
|
| Hospital Charge Code |
41601127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.56 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$9.11
|
| Rate for Payer: Aetna Medicare |
$3.56
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$3.56
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$6.20
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$6.74
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$4.09
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$3.92
|
| Rate for Payer: Cash Price |
$6.69
|
| Rate for Payer: Cash Price |
$6.69
|
| Rate for Payer: Centivo All Commercial |
$5.50
|
| Rate for Payer: Cigna All Commercial |
$9.31
|
| Rate for Payer: CORVEL All Commercial |
$10.03
|
| Rate for Payer: Coventry All Commercial |
$9.50
|
| Rate for Payer: Encore All Commercial |
$9.93
|
| Rate for Payer: Frontpath All Commercial |
$9.93
|
| Rate for Payer: Humana ChoiceCare |
$9.32
|
| Rate for Payer: Humana Medicare |
$5.50
|
| Rate for Payer: Lucent All Commercial |
$5.50
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.71
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$8.09
|
| Rate for Payer: PHP All Commercial |
$8.18
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$4.21
|
| Rate for Payer: Sagamore Health Network All Products |
$8.33
|
| Rate for Payer: Signature Care EPO |
$8.96
|
| Rate for Payer: Signature Care PPO |
$9.50
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$9.17
|
| Rate for Payer: United Healthcare Commercial |
$8.50
|
| Rate for Payer: United Healthcare Medicare |
$3.56
|
|
|
HC STYLETTE 12FR
|
Facility
IP
|
$10.79
|
|
| Hospital Charge Code |
41601127
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$10.03 |
| Rate for Payer: Aetna Commercial |
$9.32
|
| Rate for Payer: Cash Price |
$6.69
|
| Rate for Payer: Cigna All Commercial |
$9.31
|
| Rate for Payer: CORVEL All Commercial |
$10.03
|
| Rate for Payer: Coventry All Commercial |
$9.50
|
| Rate for Payer: Encore All Commercial |
$9.93
|
| Rate for Payer: Frontpath All Commercial |
$9.93
|
| Rate for Payer: Humana ChoiceCare |
$9.32
|
| Rate for Payer: Lutheran Preferred All Commercial |
$9.71
|
| Rate for Payer: PHCS All Commercial |
$8.09
|
| Rate for Payer: PHP All Commercial |
$8.18
|
| Rate for Payer: Sagamore Health Network All Products |
$8.33
|
| Rate for Payer: Signature Care EPO |
$8.96
|
| Rate for Payer: Signature Care PPO |
$9.50
|
| Rate for Payer: United Healthcare Commercial |
$8.50
|
|
|
HC STYLETTE LARGE GREEN
|
Facility
IP
|
$15.32
|
|
| Hospital Charge Code |
41601128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.49 |
| Max. Negotiated Rate |
$14.25 |
| Rate for Payer: Aetna Commercial |
$13.24
|
| Rate for Payer: Cash Price |
$9.50
|
| Rate for Payer: Cigna All Commercial |
$13.22
|
| Rate for Payer: CORVEL All Commercial |
$14.25
|
| Rate for Payer: Coventry All Commercial |
$13.48
|
| Rate for Payer: Encore All Commercial |
$14.10
|
| Rate for Payer: Frontpath All Commercial |
$14.09
|
| Rate for Payer: Humana ChoiceCare |
$13.23
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.79
|
| Rate for Payer: PHCS All Commercial |
$11.49
|
| Rate for Payer: PHP All Commercial |
$11.62
|
| Rate for Payer: Sagamore Health Network All Products |
$11.83
|
| Rate for Payer: Signature Care EPO |
$12.72
|
| Rate for Payer: Signature Care PPO |
$13.48
|
| Rate for Payer: United Healthcare Commercial |
$12.07
|
|
|
HC STYLETTE LARGE GREEN
|
Facility
OP
|
$15.32
|
|
| Hospital Charge Code |
41601128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.06 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$12.93
|
| Rate for Payer: Aetna Medicare |
$5.06
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.06
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$8.80
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.58
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$5.81
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.56
|
| Rate for Payer: Cash Price |
$9.50
|
| Rate for Payer: Cash Price |
$9.50
|
| Rate for Payer: Centivo All Commercial |
$7.81
|
| Rate for Payer: Cigna All Commercial |
$13.22
|
| Rate for Payer: CORVEL All Commercial |
$14.25
|
| Rate for Payer: Coventry All Commercial |
$13.48
|
| Rate for Payer: Encore All Commercial |
$14.10
|
| Rate for Payer: Frontpath All Commercial |
$14.09
|
| Rate for Payer: Humana ChoiceCare |
$13.23
|
| Rate for Payer: Humana Medicare |
$7.81
|
| Rate for Payer: Lucent All Commercial |
$7.81
|
| Rate for Payer: Lutheran Preferred All Commercial |
$13.79
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$11.49
|
| Rate for Payer: PHP All Commercial |
$11.62
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$5.97
|
| Rate for Payer: Sagamore Health Network All Products |
$11.83
|
| Rate for Payer: Signature Care EPO |
$12.72
|
| Rate for Payer: Signature Care PPO |
$13.48
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.02
|
| Rate for Payer: United Healthcare Commercial |
$12.07
|
| Rate for Payer: United Healthcare Medicare |
$5.06
|
|
|
HC STYLETTE MEDIUM GRAY
|
Facility
IP
|
$15.84
|
|
| Hospital Charge Code |
41601129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.88 |
| Max. Negotiated Rate |
$14.73 |
| Rate for Payer: Aetna Commercial |
$13.69
|
| Rate for Payer: Cash Price |
$9.82
|
| Rate for Payer: Cigna All Commercial |
$13.67
|
| Rate for Payer: CORVEL All Commercial |
$14.73
|
| Rate for Payer: Coventry All Commercial |
$13.94
|
| Rate for Payer: Encore All Commercial |
$14.58
|
| Rate for Payer: Frontpath All Commercial |
$14.57
|
| Rate for Payer: Humana ChoiceCare |
$13.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.26
|
| Rate for Payer: PHCS All Commercial |
$11.88
|
| Rate for Payer: PHP All Commercial |
$12.01
|
| Rate for Payer: Sagamore Health Network All Products |
$12.23
|
| Rate for Payer: Signature Care EPO |
$13.15
|
| Rate for Payer: Signature Care PPO |
$13.94
|
| Rate for Payer: United Healthcare Commercial |
$12.48
|
|
|
HC STYLETTE MEDIUM GRAY
|
Facility
OP
|
$15.84
|
|
| Hospital Charge Code |
41601129
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna Medicare |
$5.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.75
|
| Rate for Payer: Cash Price |
$9.82
|
| Rate for Payer: Cash Price |
$9.82
|
| Rate for Payer: Centivo All Commercial |
$8.08
|
| Rate for Payer: Cigna All Commercial |
$13.67
|
| Rate for Payer: CORVEL All Commercial |
$14.73
|
| Rate for Payer: Coventry All Commercial |
$13.94
|
| Rate for Payer: Encore All Commercial |
$14.58
|
| Rate for Payer: Frontpath All Commercial |
$14.57
|
| Rate for Payer: Humana ChoiceCare |
$13.68
|
| Rate for Payer: Humana Medicare |
$8.08
|
| Rate for Payer: Lucent All Commercial |
$8.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.26
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$11.88
|
| Rate for Payer: PHP All Commercial |
$12.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.18
|
| Rate for Payer: Sagamore Health Network All Products |
$12.23
|
| Rate for Payer: Signature Care EPO |
$13.15
|
| Rate for Payer: Signature Care PPO |
$13.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.46
|
| Rate for Payer: United Healthcare Commercial |
$12.48
|
| Rate for Payer: United Healthcare Medicare |
$5.23
|
|
|
HC STYLETTE SMALL BLUE
|
Facility
IP
|
$15.84
|
|
| Hospital Charge Code |
41601449
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.88 |
| Max. Negotiated Rate |
$14.73 |
| Rate for Payer: Aetna Commercial |
$13.69
|
| Rate for Payer: Cash Price |
$9.82
|
| Rate for Payer: Cigna All Commercial |
$13.67
|
| Rate for Payer: CORVEL All Commercial |
$14.73
|
| Rate for Payer: Coventry All Commercial |
$13.94
|
| Rate for Payer: Encore All Commercial |
$14.58
|
| Rate for Payer: Frontpath All Commercial |
$14.57
|
| Rate for Payer: Humana ChoiceCare |
$13.68
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.26
|
| Rate for Payer: PHCS All Commercial |
$11.88
|
| Rate for Payer: PHP All Commercial |
$12.01
|
| Rate for Payer: Sagamore Health Network All Products |
$12.23
|
| Rate for Payer: Signature Care EPO |
$13.15
|
| Rate for Payer: Signature Care PPO |
$13.94
|
| Rate for Payer: United Healthcare Commercial |
$12.48
|
|
|
HC STYLETTE SMALL BLUE
|
Facility
OP
|
$15.84
|
|
| Hospital Charge Code |
41601449
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.23 |
| Max. Negotiated Rate |
$121.68 |
| Rate for Payer: Aetna Commercial |
$13.37
|
| Rate for Payer: Aetna Medicare |
$5.23
|
| Rate for Payer: Anthem Blue Cross of IN Medicare |
$5.23
|
| Rate for Payer: Anthem Blue Cross of IN PPO/Exchange |
$9.10
|
| Rate for Payer: Anthem Blue Cross of IN Traditional |
$9.90
|
| Rate for Payer: CareSource Indiana of IN Hoosier Healthwise |
$121.68
|
| Rate for Payer: CareSource Indiana of IN Just 4 Me |
$6.01
|
| Rate for Payer: CareSource Indiana of IN Medicare |
$5.75
|
| Rate for Payer: Cash Price |
$9.82
|
| Rate for Payer: Cash Price |
$9.82
|
| Rate for Payer: Centivo All Commercial |
$8.08
|
| Rate for Payer: Cigna All Commercial |
$13.67
|
| Rate for Payer: CORVEL All Commercial |
$14.73
|
| Rate for Payer: Coventry All Commercial |
$13.94
|
| Rate for Payer: Encore All Commercial |
$14.58
|
| Rate for Payer: Frontpath All Commercial |
$14.57
|
| Rate for Payer: Humana ChoiceCare |
$13.68
|
| Rate for Payer: Humana Medicare |
$8.08
|
| Rate for Payer: Lucent All Commercial |
$8.08
|
| Rate for Payer: Lutheran Preferred All Commercial |
$14.26
|
| Rate for Payer: Managed Health Services Medicaid |
$121.68
|
| Rate for Payer: MDWise Medicaid |
$121.68
|
| Rate for Payer: PHCS All Commercial |
$11.88
|
| Rate for Payer: PHP All Commercial |
$12.01
|
| Rate for Payer: Plain Church Group Ministry All Commercial |
$6.18
|
| Rate for Payer: Sagamore Health Network All Products |
$12.23
|
| Rate for Payer: Signature Care EPO |
$13.15
|
| Rate for Payer: Signature Care PPO |
$13.94
|
| Rate for Payer: Three Rivers Preferred All Commercial |
$13.46
|
| Rate for Payer: United Healthcare Commercial |
$12.48
|
| Rate for Payer: United Healthcare Medicare |
$5.23
|
|
